Document Detail


Effect of lateral versus supine wedged position on development of spinal blockade and hypotension.
MedLine Citation:
PMID:  15321608     Owner:  NLM     Status:  PubMed-not-MEDLINE    
Abstract/OtherAbstract:
Aortocaval compression may not be completely prevented by the supine wedged or tilted positions. It is commonly believed, however, that the unmodified full lateral position after induction of spinal anaesthesia might allow excessive spread of the block. We therefore compared baseline arterial pressures in the supine wedged, sitting, tilted and full lateral positions in 40 women who were about to undergo elective caesarean section. They were then given spinal anaesthesia in the left lateral position and randomised to be turned to the right lateral or the supine wedged position, after which speed of onset and spread of blockade to cold sensation were measured every 2 min for 10 min and mean arterial pressure and ephedrine requirement were recorded every minute for 20 min. Baseline mean arterial pressure was 9 mmHg (95% CI 3 to 14) lower in the left lateral (measured in the upper arm) than in the sitting position; those in the supine wedged and tilted positions were intermediate. Following spinal anaesthesia, hypotension (defined as a reading </=80% of the baseline value in the same position) lasted 2.4 min longer (CI +0.6 to +4.1) in the supine wedged group, but there was no significant difference between the groups in maximum fall or ephedrine requirement. The upper level of block rose more rapidly in the supine wedged than in the lateral group and showed less variability. There is therefore no reason to fear the unmodified lateral group position, which may offer better protection against hypotension.
Authors:
H Hartley; P T Seed; H Ashworth; M Kubli; G O'Sullivan; F Reynolds
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  International journal of obstetric anesthesia     Volume:  10     ISSN:  0959-289X     ISO Abbreviation:  Int J Obstet Anesth     Publication Date:  2001 Jul 
Date Detail:
Created Date:  2004-08-23     Completed Date:  2005-02-22     Revised Date:  2006-09-18    
Medline Journal Info:
Nlm Unique ID:  9200430     Medline TA:  Int J Obstet Anesth     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  182-8     Citation Subset:  -    
Affiliation:
Department of Anaesthesia, St Thomas' Hospital, London, UK.
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